Prevalence and Correlates of Cost-Related Medication Nonadherence to Immunosuppressive Drugs After Heart Transplantation: The International Multicenter Cross-sectional Bright Study.
Sandra Schönfeld, Kris Denhaerynck, Lut Berben and 4 others
PMID 32433348WHAT IT FOUND
Cost-related nonadherence to immunosuppressants is rare overall but high in Australia, Canada, and the US.
Patients who feel financially burdened, see cost as a barrier, or are single are most at risk. Ask about these factors during follow-up.
Key findings
01The overall weighted prevalence of cost-related medication nonadherence was 2.6%, ranging from 0% in Switzerland and Brazil to 9.8% in Australia.
02Higher perceived financial burden, viewing cost as a barrier, and being single were significant risk factors for cost-related nonadherence.
03Higher intention to adhere, cost-related self-efficacy, and belief in the benefits of transplantation were protective factors.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study relied on self-reported data for medication adherence and financial status, which may introduce measurement error. The cross-sectional design cannot establish causality between the identified factors and nonadherence. The low overall prevalence of nonadherence (2.6%) meant there was insufficient statistical power to perform multivariable analyses, so the findings are based on univariable associations. The study only assessed nonadherence to immunosuppressants, not other medications the patients may have been taking.
Declared interests
The BRIGHT study was funded by research grants from the International Transplant Nurses Society, the International Society for Heart and Lung Transplantation, and the Swiss Academy of Medical Sciences.
The easy way to misread this
Do not assume that low overall prevalence means cost-related nonadherence is a minor issue. The study found significant variation by country, with rates up to 9.8% in Australia, and the univariable nature of the analysis means these factors are associated with nonadherence but not necessarily independent predictors in a complex clinical picture.